超声引导下前锯肌平面阻滞预防乳腺癌术后疼痛综合征

Ultrasound-guided serratus anterior plane block in prevention of post-mastectomy pain syndrome

目的观察超声引导下前锯肌平面阻滞(SPB)超前镇痛预防乳腺癌根治术后疼痛综合征(PMPS),其原理是否与降低炎症反应有关。方法选择2019年4月至2020年4月在我院择期拟行乳腺癌根治术的女性患者120例,采用随机数字表法分为全身麻醉组(G组)和前锯肌平面阻滞组(SPB组),每组各60例。SPB组在术前采用超声引导下0.33%罗哌卡因行前锯肌平面阻滞,G组不给予神经阻滞。记录术中患者丙泊酚及瑞芬太尼的用量;比较两组在麻醉前20 min(t_(0))、手术开始(t_(1))、手术结束(t_(2))、术后6 h(t3)及术后24 h(t4)血清中炎症因子表达水平的变化;评估患者术后6 h(T_(1))、24 h(T_(2))、48 h(T_(3))、1周(T_(4))、1个月(T_(5))、3个月(T_(6))的视觉模拟评分(VAS);记录两组术后1、3个月慢性疼痛发生率。结果SPB组术中丙泊酚和瑞芬太尼的用量低于G组(P<0.05);在t_(2)~t4时刻,SPB组白细胞介素6(IL-6)、白细胞介素10(IL-10)水平明显低于G组(P<0.05);SPB组T_(1)~T_(6)的VAS评分明显低于G组(P<0.05)。SPB组术后1、3个月慢性疼痛发生率分别为42.3%、23.0%,低于G组的62.5%、46.4%(P<0.05)。结论超声引导前锯肌平面阻滞在麻醉期间降低术后炎症因子水平,可为乳腺癌根治术提供良好的术后镇痛,有效预防乳腺癌术后疼痛综合征,且安全性较高。

Objective To observe whether ultrasound-guided anterior serratus muscle block(SPB)can prevent pain syndrome(PMPS)after radical mastectomy,and whether its principle is related to reducing inflammatory reaction.Methods A total of 120 female patients scheduled for radical mastectomy in our hospital from April 2019 to April 2020 were selected.They were randomly divided into the general anesthesia group(group G)and the serratus anterior plane block group(group SPB),with 60 cases in each group.In group SPB,0.33%ropivacaine was used in ultrasound-guided SPB before operation,while in group G,no nerve block was given.The dosage of propofol and remifentanil used in patients during operation were recorded.The levels of serum inflammatory factors in the two groups were compared at 20 min before anesthesia(t_(0)),at the beginning of operation(t_(1)),at the end of operation(t_(2)),6 h after operation(t3)and 24 h after operation(t4).The score of visual analogue scale(VAS)was evaluated at 6 h(T_(1)),24 h(T_(2)),48 h(T_(3)),1 week(T_(4)),1 month(T_(5)),3 months(T_(6))after operation.The incidence of chronic pain at 1 month and 3 months after operation was recorded in the two groups.Results The dosages of propofol and remifentanil were lower in group SPB than that in group G(P<0.05).The levels of IL-6 and IL-10 were significantly lower in group SPB than those in group G at t_(2)-t4(P<0.05).The VAS scores were significantly lower in group SPB than those in gro up G at t 1-t6(P<0.05).The incidence of chronic pain was 42.3%and 23.0%in group SPB,lower than 62.5%and 46.4%in group G at 1 and 3 months after operation(P<0.05).Conclusion Ultrasound-guided SPB can reduce the level of postoperative inflammatory factors during anesthesia,which can provide a good postoperative analgesia for radical mastectomy,and effectively prevent PMPS,with higher safety.